With reforms, more women opt for VA health care

For a lot of years, women veterans felt unwelcome in Department of Veteran Affairs hospitals and clinics, as if they weren't real veterans. Reinforcing that impression were routine referrals to multiple health-care providers, in or out of VA, to get comprehensive primary care.That is changing rapidly, thanks to VA's commitment to improve women's health services, to hire more gynecologists and other female health specialists, and to close a "gender gap" in preventive health services and screenings, says Dr. Patricia Hayes, chief consultant for Women Health Services for the Veterans Health Administration.Hayes and her staff have studies and data to show recent gains. They range from patient satisfaction surveys to numbers of staff physicians newly trained to provide for female health needs, and to a new report showing a narrowing of gender disparity in preventive health care screening.Following a 2008 report on deficiencies in primary care delivery to women, the VA decided to act."That really launched us on an overall plan to implement major changes in health care for women (to) make sure every woman veteran gets the right kind of health care," Hayes said. "We recognize that there's been a tremendous influx of women. We have beefed up and accomplished a lot, and we recognize we are still facing a large challenge ahead."Today, 17 percent of female veterans are enrolled in VA health care vs. 20 percent of male veterans. But women returning from recent conflicts are using the VA in much greater numbers then previous generations.In an interview, Hayes and Dr. Sally Haskell, acting director for comprehensive women's health, conceded that challenges remain to reach full equality of access and services for women vets, particularly in VA community-based outpatient clinics. But the recent gains have been impressive and will continue, they say."They felt unwelcomed and invisible. We are changing that culture," Hayes said.In 2008, only 33 percent of VA health care facilities offered comprehensive primary care to women. Today, women can get full primary care services at 90 percent of VA's larger hospitals and medical centers and at almost 75 percent of its community-base outpatient clinics, Haskell said.Four years ago, many female veterans visited VA clinics and were referred to larger hospitals, having then to travel "hours and hours to get basic primary care for things like birth control and (vaginal)infections and getting their mammograms arranged," said Hayes. The number of areas of the country where that's still true have fallen sharply.From 2000-09, the number of women veterans using VA health services almost doubled, to 293,000. Over the next two years it rose by another 44,000 to reach 337,000 by last October. The VA still needs to attract more staff gynecologists and other female health specialists, but it has closed much of the gap for delivering primary care by improving capabilities of current staff."Since 2008 we have trained over 1,500 primary-care providers in this intensive training on comprehensive women's health," Hayes said. "We designed what we call a mini-residency in women's health, a 40-hour program, training 35 to 40 providers at a time ... They learn things like birth control, abnormal bleeding but also mental health issues and PTSD in women and an overview of maternity care."These are folks were trained in medical school or nurse practitioner school. But they have been seeing men for so long they felt rusty in their proficiency with women," Hayes said.Despite the gains, Hayes and Haskell said many women veterans still have misconceptions about the quality of VA health care and stay away. Many still believe, for example, that only combat vets can gain access.Yet women veterans who use VA care decide to stay with it, even if they have other health insurance. Like male veterans, females are rating VA health care as being better than care in the private sector."Word is getting out among women veterans that we have great care [and] a lot more systems and services in place ... to be comfortable using VA," Hayes said.To comment, write Military Update, P.O. Box 231111, Centreville, VA, or send email to milupdate@aol.com.

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